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AET) today announced five accountable care agreements in Maine. The agreements align payment for medical services at major health systems in Maine with improved quality, efficiency and patient experiences.
The accountable care agreements are with Mercy Health System of Portland; InterMed, P.A. of Portland; MaineHealth of Portland; Martin’s Point Health Care of Portland; and MaineGeneral Health of Augusta. These agreements are expected to help improve the quality of care for Aetna members in Maine, make the health care experience simpler for members, and lower overall health care costs.
“Value-based, accountable care models will make the health care experience better for our Maine members,” said Martha Temple, president, Aetna New England. “Physicians and hospitals working in an accountable care model are incented to provide Aetna members with more outreach and coordination to make the entire experience simpler, more effective and more efficient.”
The agreements support Aetna’s commitment to develop accountable care models for the State of Maine’s employees and their dependents, which Aetna administers. In addition to serving the State of Maine’s members, the new agreements will strengthen the health care delivery system for all Aetna members in Maine who receive care from any of these health care facilities and their affiliated providers.
“For employers like the State of Maine, these agreements will help patients and their families to better manage the value and cost of health care services. We look forward to collaborating with Aetna and the ACOs,” said Joyce Oreskovich, Management Co-Chair of the State Employee Health Commission.
Payment for coordinated care and quality outcomesUnder each of the five new accountable care agreements, the providers will become part of a coordinated health care network and receive information about medical care and medications a patient may be receiving. By having access to information about the patient’s range of health care interactions, providers can better coordinate their patient’s care. Easier coordination and information sharing can help reduce duplicate testing and appointments, and make the health care experience simpler for the patient.
This care will be supported by changes in the way these hospitals and providers are reimbursed for care with certain payments based on the achievement of mutually agreed upon measures of quality, efficiency and patient outcomes. The measures include, but are not limited to:
The percentage of Aetna members who get recommended preventive care and screenings;
Better management of patients with chronic conditions such as diabetes and heart failure;
Reductions in hospital readmission rates; and
Reductions in avoidable emergency room visits by improving primary care access hours.
These measures are designed to:
Improve the patient’s health care experience through greater care coordination and patient engagement;
Improve the health of populations; and
Reduce the costs of health care by eliminating duplicate services and unnecessary testing.
Accountable care collaboration has been working in MaineSince 2008, Aetna has had a Medicare Provider Collaboration model with NovaHealth/InterMed to support Medicare Advantage members. NovaHealth/InterMed physicians participating in Aetna’s Medicare Provider Collaboration program have provided care to approximately 1,400 Aetna Medicare Advantage members. Through the program, Aetna and NovaHealth/InterMed have achieved two main goals of accountable care collaborations: improving quality of care and lowering health care costs. The results of the collaboration received national recognition and were published in the September, 2012 issue of
Health Affairs. Among the positive impacts were:
Significantly reduced hospital admissions and readmissions;
Increased preventive care; and
Reduced health care costs for the study population compared to unmanaged Medicare members.
Unique aspects of each agreement
Extending the programs that have produced nationally recognized results for the Medicare Advantage members, Aetna’s latest agreement with InterMed will cover approximately 8,400 commercial members who receive care from an InterMed primary care physician and reside in Cumberland or York counties.
As one of the sought-after health care practices in Portland, InterMed is increasing the use of health information and technology to improve care management and supporting better health for its patients.
Mercy Health System
The Mercy Health ACO will serve Aetna members who live in York and Cumberland counties. Aetna members served by this new model are ones who primarily received care from Mercy Health System’s more than nine affiliated primary care physicians and 16 specialty care practices in the last 24 months.
Mercy also is part of Aetna’s Institutes of Quality (IOQ) for Joint Replacement. Facilities earn IOQ status for having high volumes and producing clear clinical results in the area of their specialty.
The agreement with the MaineHealth Accountable Care Organization will cover approximately 9,000 Aetna members who live in Cumberland, York, Androscoggin, Knox, Waldo, Lincoln, Oxford or Sagadahoc counties and receive primary care from a MaineHealth provider.
MaineHealth is the parent organization of the largest tertiary care center in Maine, Maine Medical Center, as well as eight additional hospitals. The MaineHealth ACO works in partnership with the MMC PHO, which includes over 1,500 physicians. The MaineHealth ACO also includes St. Mary’s Regional Medical Center in Lewiston.
MaineHealth is an Aetna designated Institute of Quality (IOQ) for cardiac, bariatric, hip and knee surgery.
Martin’s Point Health Care
The Martin’s Point agreement will benefit 6,200 Aetna members who live in York, Cumberland, Androscoggin, Sagadahoc and Penobscot counties in Maine; and Stratford and Rockingham Counties in New Hampshire.
The agreement will give patients access to highly coordinated care from Martin’s Point Health Care physicians.
Martin’s Point has nine health care centers offering primary and specialty care in Maine and New Hampshire. Martin’s Point is committed to improving health outcomes, lowering the cost of care and improving customer experience.
MaineGeneral Health and Aetna, working with the Kennebec Region Health Alliance, have entered into an agreement that will serve an estimated 1,700 members in Kennebec, Androscoggin, Somerset, Franklin, Waldo, Sagadahoc and Lincoln counties. Kennebec Region Health Alliance is a large physician hospital organization in Augusta and Waterville.
Through the MaineGeneral Health ACO, Aetna members will receive enhanced coordinated care. The Alliance will use information technology to assist in coordinating care and in actively engaging Aetna members in maintaining their overall health.
Maine General Health includes more than 250 physicians covering a number of specialties.
About AetnaAetna is one of the nation’s leading diversified health care benefits companies, serving an estimated 44 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see